Tuesday, August 24, 2010

Dying of Thirst: Joshua (Kulendran Mayandi)

Brampton Civic Hospital

On Friday, August 20, 2010, I published a blog post about Joshua (Kulendran Mayandi), a 48 year old pastor of a small pentecostal Church in Brampton who had a heart attack on May 29. Joshua is at the Brampton Civic Hospital (William Osler Health Centre) where his IV fluids, food and medication have been removed since Tuesday, August 17.Link to my August 20 blog comment: Brampton Civic Hospital imposes euthanasia by dehydration through pressure tactics: http://alexschadenberg.blogspot.com/2010/08/brampton-civic-hospital-imposes.htmlJoshua was first in coma. He then came out of coma and has recovered a little but he remains cognitively disability. He has the ability to recognize his closest friends and respond with one-word answers and sometimes with multi-word responses. He is able to move his body and appears to be physiologically stable.Joshua is not otherwise dying. There is no indication that Joshua will experience a heart attack again. Other than the fact that Joshua is cognitively disabled he is otherwise healthy and could possibly live many years in this condition.I have received an incredible number of emails supporting Joshua. Thank you to everyone who sent an email or a letter. I have also received several emails questioning my point of view, especially in relation to the use of assisted techniques to provide hydration (fluid) and nutrition (food).Therefore I will clarify my position.Euthanasia is an action or omission of an action which of itself and by intention causes the death of a person for the reason of suffering.In other words, to directly and intentionally cause the death of a person by action or omission, whereby the death is the result of the action or omission, is euthanasia, when the intention is to relieve suffering.It is not euthanasia to withhold or withdraw medical treatment, especially when it is burdensome, extra-ordinary, disproportionate, etc.Joshua is not otherwise dying. The intention is to directly cause his death by dehydration. If the SDM or the hospital do not provide hydration or nutrition, Joshua will intentionally die from dehydration.

Even if the law fails to recognize it, this is a form of euthanasia because death is directly and intentionally caused by dehydration and not by his medical condition.In this case, Joshua may be capable of effectively eating and drinking by mouth, but due to the traecheotomy, he is currently unable to be fed or hydrated effectively without medical assistance.Joseph has been breathing for a long period of time without medical assistance, why has the traech not been plugged?Many people believe that providing assisted hydration and nutrition is always a form of medical treatment and therefore always optional. This is a false concept.To provide fluids and food, by assisted means, should be considered normal care. Normal care is what we owe everyone in society. It is part of our social contract that enables us to live together in society in peace and harmony.Fluids and food are not a type of medical treatment. In and of itself, fluids and food do not treat a condition but rather they simply allow the normal process of living to continue.Assisted fluids and food can be provided at home by most people, when provided with a minimal level of training. It is not extra-ordinary, it is not disproportionate, it is not excessive or burdensome.Fluids and food are a basic necessity of life.Recently, Dr Jean Turner - executive director of Scotlands Patients Association (SPA), a GP and former independent MSP - warned that hundreds of patients, particularly the elderly, are languishing in hospital beds because they are not given help with feeding or hydration.Turner referred to this problem as a form of euthanasia. She was right. We need a Canadian Patients Association to fight for people like Joshua.Link to my blog comment on the Scottish article: http://alexschadenberg.blogspot.com/2010/08/intentional-malnutrition-of-scottish.htmlJoshua's case should not be compared to palliative care cases, when the person is actually dying and nearing death. Joshua is not otherwise dying, but if his treatment plan is not changed, he will directly and intentionally die from dehydration.When a person is actually dying the circumstance and the intention is very different. Providing fluids and food to a dying person will often, but not always, be more of a burden than a benefit.When a person is dying they experience a process related to the shutting down of the body. When the body shuts down, the provision of fluids or food loses its purpose because the body becomes unable to absorb or assimilate it.People with acquired disabilities, such as Joshua, should not be dehydrated to death because they are unlikely to fully recover. Many people live with cognitive, or other disabilities, and society does not have the right to determine whether they should live or whether they should die.The hospital/doctor and the Substitute Decision Maker (SDM) should not have the right to decide who should live and who should die. We need a legal system whereby the best interest of a person is guaranteed under the law.Article 25 (f) of the Convention on the Rights of Persons with Disabilities states: Prevent discriminatory denial of health care or health services or food and fluids on the basis of disability. (http://www.un.org/disabilities/convention/conventionfull.shtml)Just because a hospital and an SDM have agreed to withhold all IV fluids, food and medication, does not mean that they should have the legal right to do so. The law must always prevent the direct and intentional causing of death by medical means or omissions. Direct and intentional killing must be illegal outside the accepted practise of medicine.For the sake of justice and equality for all, Joshua needs hydration (fluids) and nutrition, to once again be provided to him. He deserves the opportunity to recover, to whatever degree possible, and he deserves the right to live, even when society and others deem his life as not worth living.Signs of dehydration: http://bodyandhealth.canada.com/channel_condition_info_details.asp?disease_id=153&channel_id=9&relation_id=10860To prevent yourself from being dehydrated to death, contact the Euthanasia Prevention Coalition at: euthanasiaprevention@on.aibn.com and order the Life Protecting Power of Attorney for Personal Care for $25 each.

5 comments:

Anonymous
said...

Please look up the name janet Rivera of fresno. I am Michael Dancoff her brother. We successfully made sure that she received food and nutrition. She is currently breathing on her own and is tracking our movement with her eyes. Joshua needs food and nutrition now. From the report I just read. He is not dying, he is alive.

Alex as a palliative care nurse I thank you for your understanding and clear delineation of the differences between not forcing food and fluids upon a person dying of cancer or some other illness, and withdrawal of food and fluids from a dependent person not dying of their condition (aka Terri Schaivo and Joshua). Praying for Joshua and all involved that they will change his course of treatment.

This man is not dying, but will if they don't give him hydration. To me for the hospital via their decision or via being pressured to do so by his family to deny him hydration is the equivalent of murder. I think it is cruel and inhuman for family members to bring about his death just because he may have sustained a brain injury, where as otherwise he most likely would live. Goes to show you societies value of "imperfect human beings." So sad.

Chances are that given hydration and nutrition Joshua's condition will continue to improve over time. How about asking Joshua, with a video camera and operator available, if he wants to live? A number of easy questions can be asked first that require a simple YES/NO answer to establish that he can understand the meaning of simple questions - which can be something like telling him to raise his hand for "YES" and keeping his hand flat down for "NO" . Even though I think the medical profession is morally bound to provide nutrition and hydration even if his answer to the key question is "NO", it would help get the word out that persons in semi-comas can continue to think.

When I was nearly comatose, and had lost the ability to speak above a whisper - my mind was still working normally and so was my hearing. My vision was impaired, I had a loud roaring in my brain, I couldn't eat solids because there was no saliva to begin the digestive process BUT I COULD STILL THINK.

If Joshua responds with "YES" it will put the heat level up for saving his life. Put the video on UTube.

Good heavens what is going on here on this blog. As a doctor there is little explained in this blog medically indicating the condition he has and his cognitive state. If he is in a vegetative state or near to from anoxic brain injury from his infarction he has little hope of a full recovery.If a patient is unable to eat due to a permanent or likely permanent cognitive incapacity, to feed or not feed is the choice of the patient or SDM, not society. To feed is active and extra-ordinary means and to with hold is not euathanasia it is humanitarian. These happen all the time as it is a patient choice! When you go to hospital you are asked what measures you want to be kept alive, artificial feeding is a choice. Personally if I was in such a state with hold my feeding too. There is something to be said for quality of life and not simply quanitity. Please provide the medical facts before your peurile comments are sent forth here. Do not descant on anecdotes or overlook patient choice and family choice. I respect life and my patients. If this was an informed decision and indeed the incapacity is likely permanent, we should support as a community the difficult choice the family had to make.